|
NM Pulmonary Perfusion Imaging
|
Facility
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
1169328
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$791.00 |
| Max. Negotiated Rate |
$1,017.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,017.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,017.00
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$847.50
|
| Rate for Payer: Medical Associates Commercial |
$847.50
|
| Rate for Payer: Midlands Choice Commercial |
$791.00
|
| Rate for Payer: United Healthcare Commercial |
$1,017.00
|
|
|
NM Pulmonary Ventilation/Perfusion
|
Facility
OP
|
$1,745.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
1169346
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$872.15 |
| Max. Negotiated Rate |
$1,822.99 |
| Rate for Payer: Aetna of IA Commercial |
$1,570.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,570.50
|
| Rate for Payer: Aetna of IA Medicare |
$994.65
|
| Rate for Payer: Amerigroup Medicaid |
$880.70
|
| Rate for Payer: Amerigroup Medicare |
$881.22
|
| Rate for Payer: Cash Price |
$1,396.00
|
| Rate for Payer: Cash Price |
$1,396.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,308.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$872.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$872.15
|
| Rate for Payer: Medical Associates Commercial |
$1,308.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$872.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,221.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$885.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,308.75
|
| Rate for Payer: United Healthcare Commercial |
$1,570.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,029.55
|
| Rate for Payer: Wellmark IA HMO |
$1,657.26
|
| Rate for Payer: Wellmark IA PPO |
$1,822.99
|
|
|
NM Pulmonary Ventilation/Perfusion
|
Facility
IP
|
$1,745.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
1169346
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,221.50 |
| Max. Negotiated Rate |
$1,570.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,570.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,570.50
|
| Rate for Payer: Cash Price |
$1,396.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,308.75
|
| Rate for Payer: Medical Associates Commercial |
$1,308.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,221.50
|
| Rate for Payer: United Healthcare Commercial |
$1,570.50
|
|
|
NM Thyroid Imaging Only
|
Facility
IP
|
$1,190.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
1169390
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$833.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,071.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,071.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$892.50
|
| Rate for Payer: Medical Associates Commercial |
$892.50
|
| Rate for Payer: Midlands Choice Commercial |
$833.00
|
| Rate for Payer: United Healthcare Commercial |
$1,071.00
|
|
|
NM Thyroid Imaging Only
|
Facility
OP
|
$1,190.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
1169390
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$594.76 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,071.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,071.00
|
| Rate for Payer: Aetna of IA Medicare |
$678.30
|
| Rate for Payer: Amerigroup Medicaid |
$600.59
|
| Rate for Payer: Amerigroup Medicare |
$600.95
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$892.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$595.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$594.76
|
| Rate for Payer: Medical Associates Commercial |
$892.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$595.00
|
| Rate for Payer: Midlands Choice Commercial |
$833.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$603.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$702.10
|
| Rate for Payer: Wellmark IA HMO |
$879.16
|
| Rate for Payer: Wellmark IA PPO |
$967.08
|
|
|
NM Thyroid Imaging w/ Uptake Single
|
Facility
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
1169394
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$719.21 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Aetna of IA Medicare |
$820.23
|
| Rate for Payer: Amerigroup Medicaid |
$726.26
|
| Rate for Payer: Amerigroup Medicare |
$726.70
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$719.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$719.21
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$719.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$730.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,079.25
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$849.01
|
| Rate for Payer: Wellmark IA HMO |
$879.16
|
| Rate for Payer: Wellmark IA PPO |
$967.08
|
|
|
NM Thyroid Imaging w/ Uptake Single
|
Facility
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
1169394
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,007.30 |
| Max. Negotiated Rate |
$1,295.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,295.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,295.10
|
| Rate for Payer: Cash Price |
$1,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,079.25
|
| Rate for Payer: Medical Associates Commercial |
$1,079.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,007.30
|
| Rate for Payer: United Healthcare Commercial |
$1,295.10
|
|
|
NM Thyroid Uptake Single Determination
|
Facility
OP
|
$1,190.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
1169400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$594.76 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,071.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,071.00
|
| Rate for Payer: Aetna of IA Medicare |
$678.30
|
| Rate for Payer: Amerigroup Medicaid |
$600.59
|
| Rate for Payer: Amerigroup Medicare |
$600.95
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$892.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$595.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$594.76
|
| Rate for Payer: Medical Associates Commercial |
$892.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$595.00
|
| Rate for Payer: Midlands Choice Commercial |
$833.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$603.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$892.50
|
| Rate for Payer: United Healthcare Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$702.10
|
| Rate for Payer: Wellmark IA HMO |
$879.16
|
| Rate for Payer: Wellmark IA PPO |
$967.08
|
|
|
NM Thyroid Uptake Single Determination
|
Facility
IP
|
$1,190.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
1169400
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$833.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,071.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,071.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$892.50
|
| Rate for Payer: Medical Associates Commercial |
$892.50
|
| Rate for Payer: Midlands Choice Commercial |
$833.00
|
| Rate for Payer: United Healthcare Commercial |
$1,071.00
|
|
|
Non-bacterial Infection of Nervous System Except Viral Meningitis With CC
|
Facility
IP
|
$12,511.68
|
|
|
Service Code
|
MS-DRG 098
|
| Hospital Charge Code |
778
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,511.68 |
| Rate for Payer: Amerigroup Medicaid |
$12,451.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,330.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,511.68
|
|
|
Non-bacterial Infection of Nervous System Except Viral Meningitis With MCC
|
Facility
IP
|
$20,606.08
|
|
|
Service Code
|
MS-DRG 097
|
| Hospital Charge Code |
777
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$20,606.08 |
| Rate for Payer: Amerigroup Medicaid |
$20,506.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20,307.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,606.08
|
|
|
Non-bacterial Infection of Nervous System Except Viral Meningitis Without CC/MCC
|
Facility
IP
|
$8,734.16
|
|
|
Service Code
|
MS-DRG 099
|
| Hospital Charge Code |
779
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,734.16 |
| Rate for Payer: Amerigroup Medicaid |
$8,691.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,607.58
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,734.16
|
|
|
NON COVERED MILEAGE PER 10TH OF A MILE
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
CPT A0888
|
| Hospital Charge Code |
5966786
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of IA Commercial |
$1.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.80
|
| Rate for Payer: Aetna of IA Medicare |
$1.14
|
| Rate for Payer: Amerigroup Medicaid |
$1.01
|
| Rate for Payer: Amerigroup Medicare |
$1.01
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.00
|
| Rate for Payer: Medical Associates Commercial |
$1.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.00
|
| Rate for Payer: Midlands Choice Commercial |
$1.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.50
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.70
|
|
|
NON COVERED MILEAGE PER 10TH OF A MILE
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
CPT A0888
|
| Hospital Charge Code |
5966786
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of IA Commercial |
$1.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.50
|
| Rate for Payer: Medical Associates Commercial |
$1.50
|
| Rate for Payer: Midlands Choice Commercial |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
|
|
Non-extensive Burns
|
Facility
IP
|
$5,548.17
|
|
|
Service Code
|
MS-DRG 935
|
| Hospital Charge Code |
647
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,548.17 |
| Rate for Payer: Amerigroup Medicaid |
$5,521.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,467.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,548.17
|
|
|
Non-extensive O.R. Procedures Unrelated to Principal Diagnosis With CC
|
Facility
IP
|
$16,968.33
|
|
|
Service Code
|
MS-DRG 988
|
| Hospital Charge Code |
676
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,968.33 |
| Rate for Payer: Amerigroup Medicaid |
$16,886.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16,722.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,968.33
|
|
|
Non-extensive O.R. Procedures Unrelated to Principal Diagnosis With MCC
|
Facility
IP
|
$23,345.22
|
|
|
Service Code
|
MS-DRG 987
|
| Hospital Charge Code |
675
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$23,345.22 |
| Rate for Payer: Amerigroup Medicaid |
$23,232.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23,006.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23,345.22
|
|
|
Non-extensive O.R. Procedures Unrelated to Principal Diagnosis Without CC/MCC
|
Facility
IP
|
$7,349.33
|
|
|
Service Code
|
MS-DRG 989
|
| Hospital Charge Code |
677
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,349.33 |
| Rate for Payer: Amerigroup Medicaid |
$7,313.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,242.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,349.33
|
|
|
NON-LOCKING SCREW 2.7MMX14MM
|
Facility
OP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8759894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.96 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Aetna of IA Medicare |
$123.12
|
| Rate for Payer: Amerigroup Medicaid |
$109.02
|
| Rate for Payer: Amerigroup Medicare |
$109.08
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$108.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.96
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$127.44
|
|
|
NON-LOCKING SCREW 2.7MMX14MM
|
Facility
IP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8759894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
|
|
NON-LOCKING SCREW 3.5MMX12MM
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8793251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
NON-LOCKING SCREW 3.5MMX12MM
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8793251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
NON-LOCKING SCREW 3.5MMX16MM
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8884277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
NON-LOCKING SCREW 3.5MMX16MM
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8884277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$90.85
|
| Rate for Payer: Amerigroup Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.96
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
|
Non-malignant Breast Disorders With CC/MCC
|
Facility
IP
|
$9,803.04
|
|
|
Service Code
|
MS-DRG 600
|
| Hospital Charge Code |
398
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,803.04 |
| Rate for Payer: Amerigroup Medicaid |
$9,755.69
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,660.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,803.04
|
|
